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Blue Cross HMO to Test Savings: Maintenance Drugs Will Cost Less

Posted on: Saturday, 18 March 2006, 06:00 CST

By Katie Merx, Detroit Free Press

Mar. 18--Three new Blue Care Network prescription programs will test the theory that charging patients less for their medicines could reduce health-care costs.

Blue Cross Blue Shield of Michigan's Southfield-based health maintenance organization will run three programs this year that will charge members less for some maintenance medicines, even brand-name drugs.

"By reducing copayments, we're not only saving our individual members and group customers money, we also are helping keep BCN members healthier by making it easier for them financially to maintain a proper drug regimen," said Marc Keshishian, the network's vice president and medical director of clinical affairs.

* Beginning this month, Blue Care Network will endorse pill splitting for patients who take Lipitor or Zocor if their doctors approve. Consumers will pay just one month's co-pay for 60 days' worth of the drug.

This month the company sent plastic pill-splitting devices to the 18,000 network members who take those drugs. The HMO is encouraging those members to talk to their doctors to see whether pill splitting is appropriate for them. If their doctors give consent, those patients can purchase the medicines in twice the dose they normally take and then split those pills so they last for two months. The savings to the patient: six co-pays instead of 12.

* In mid-April, network members who take maintenance drugs for chronic conditions will be able to purchase a 90-day supply at a 60-day price at most Michigan pharmacies. Previously, a reduced copay was available only through a mail-order pharmacy.

* In January, the HMO started a one-year pilot program that makes seven brand-name asthma-control medications available to patients at the generic-drug price. For example, if a member's plan charges $40 for brand-name drugs and $10 for generic drugs, the patient now would now pay $10 for a brand-name asthma-control medicine. Covered medications are Asmanex, Azmacort, Flovent, Intal, Pulmicort, QVAR and Tilade. Those drugs are used to prevent asthma attacks, not for quick relief.

The hope is that spending more on prescription drugs could end up costing everybody less in the long run because it will encourage people to take medicines that keep them healthy, working and out of the hospital.

There's evidence that charging less for necessary drugs cuts per-patient costs. Pitney Bowes Inc. has saved more than $1 million each year since it cut employees' copays for diabetes, hypertension and asthma drugs. And the city of Asheville, N.C., reduced the average annual cost of care for its diabetic workers by $2,000 per person as soon as it started paying the whole cost of diabetes drugs.

"I take Lipitor, and anything that would save me money on it would be good for me, whether it's splitting pills or getting 90 days' worth for the 60-day price," said Mike Strong, 36, of Macomb Township.

Blue Cross said it started the programs after it completed a member satisfaction survey last year and found that the leading reason for dissatisfaction was the cost of prescription drug copays.

"So we're lowering copays to see if that improves compliance," said Kim Tonkavich, pharmacy director for Blue Care Network health centers. "Hopefully, at the end of the year we'll see decreased use of emergency rooms, decreased hospitalization and increased quality of life."

Mark Fendrick, codirector at the University of Michigan Center for Value-Based Insurance Design, said he's excited about the new programs.

"We're hopeful that the further removal of financial barriers for highly effective and underused medical interventions will be adopted by other health plans and self-insured employees," Fendrick said. "We strongly believe that this is the right thing to do and will pay off in both better clinical outcomes and the economic bottom line."

In addition to patient savings, Blue Care Network could save $1 million in Lipitor and Zocor costs with pill-splitting if 25% of eligible members participate. The HMO might spend more on the asthma medicines but it anticipates that spending will save it money on hospitalizations and doctor visits.

"The goal is to improve members' compliance with their medications and save dollars on the medical side," Tonkavich said.

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Source: Detroit Free Press

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